ijph-2021-1603993 1..16

Professional Characteristics of Health

Promotion: A Scoping Review of the

German and International Literature

Verena Biehl

*, Thomas Gerlinger

and Frank Wieber

School of Health Professions, Institute of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland,

Department of Health Care Systems, Health Policy and Sociology of Health, Faculty of Health Sciences, University of Bielefeld,

Bielefeld, Germany,

Department of Psychology, University of Konstanz, Konstanz, Germany

Objective: This scoping review investigates current developments in the professional

characteristics of health promotion (HP) with a focus on the German speaking part

of Europe. The conceptualization of HP is a prerequisite for progressing HP

professionalization and clarifying the interconnectedness between HP and Public Health.

Methods: The search strategy was informed by sociological professionalization theories.

Original publications were included in a content-based analysis.

Results: Ninety publications (37 original publications) were identiﬁed in the review. The

results are summarized in categories based on professional characteristics: 1) profession,

2) ethics, 3) education/training 4) competencies, and 5) quality. The professionalization of

HP regarding the professional characteristics is less developed in the German compared

to the international literature.

Conclusion: The mixed ﬁndings emphasize the relevance of a common HP

conceptualization. The HP core competencies, which have been developed by the

International Union for Health Promotion and Education must be further promoted. A

strong HP workforce within Public Health strengthens the HP status in policy contexts and

society and its contribution to promoting health and tackling social inequalities in health.

Keywords: health promotion, public health, professionalization, professional characteristics, professional

competencies

INTRODUCTION

In pursuing the overarching goal of preventing and managing health problems worldwide, health

promotion (HP) offers valuable competencies that can contribute to political and societal efforts.

With its focus on socioenvironmental determinants of health at a community level as described in the

Ottawa Charta in 1986, HP has the potential to promote health and well-being for all groups of

society [1,2]. In line with this increasing recognition of the relevance of HP, the United Nations

explicitly referred to it in the Sustainable Development Goals for 2030 in goal 3: “Enable healthy lives

and promote well-being for all at all ages” [3]. These goals are particularly important given that

individualism, urbanization and globalization are driving many major contemporary health issues,

including noncommunicable diseases, and call for rethinking our health systems with a strengthened

focus on HP and prevention that complements the traditional focus on disease management and

health care [4,5]. However, the often suboptimal quality of HP practice [ 6 –8] and the lack of Public

Edited by:

Alberto Borraccino,

University of Turin, Italy

Reviewed by:

Dean Whitehead,

University of Tasmania, Australia

Helen Keleher,

Monash University, Australia

*Correspondence:

Verena Biehl

[email protected]

Received: 24 January 2021

Accepted: 04 June 2021

Published: 01 July 2021

Citation:

Biehl V, Gerlinger T and Wieber F

(2021) Professional Characteristics of

Health Promotion: A Scoping Review

of the German and

International Literature.

Int J Public Health 66:1603993.

doi: 10.3389/ijph.2021.1603993

Int J Public Health | Owned by SSPH+ | Published by Frontiers July 2021 | Volume 66 | Article 16039931

International Journal of Public Health

REVIEW

published: 01 July 2021

doi: 10.3389/ijph.2021.1603993

Health (PH) professionals [9,10] call for a stronger HP workforce.

Although HP has come a long way since the 1980s, it is not well-

established as a profession in our society yet, at least in the

German speaking part of Europe [11–15].

For better comprehensibility the following section provides

descriptions for the central terms in this article and their relation

between each other referring to Mieg, 2016 [16].

Professionalization in this article is understood as an overall

term for the development of the ﬁeld of action of HP being

performed by professionals. Within the professionalization

process a main requirement is the conceptualization of the

concrete ﬁeld of action, which can then be described by

speciﬁc professional characteristics. As identiﬁcation of

professional characteristics therefore represents a central

building block to support the development of the HP

profession, this study aims to provide an overview of the

professional characteristics of the HP profession described in

the literature. Thereby, professional characteristics don’t capture

the analysis of a whole profession but facilitate the understanding

of different relevant aspects of a single profession. We understand

professional HP as it was conceptualized in the Ottawa Charta: a

salutogenic perspective on health focusing on populations based

on the principles of participation, empowerment and health

equity. HP is a multilayered concept to initiate a paradigm

shift within our health systems to a state of Health in all

Policies [1]. This means many professions are involved in this

paradigm shift including a speciﬁc profession - the HP

practitioner.

Professionals are needed to face complex challenges in today’s

knowledge-oriented societies, such as the promotion of well-being

and population health. As systematic approaches to describe

professional characteristics, a variety of sociological theories on

professionalization have been developed since the early 20

century. For instance, professional characteristic theories

represent pragmatic approaches to the issue of professionalization

that focus mainly on the institutional level, namely on education and

training institutions, professional institutions or a code of ethics

[17–19]. Since the 1980s, however, the focus shifted to the individual

level of professions, such as the professional performance [20],

competencies and professional identity [16]. A combination of

different approaches that distinguishes the institutional level and

the individual level of professionalization was then suggested by

Mieg [16]. Summarizing these different professional characteristics

on institutional and individual level [16–20] leads to the following

shortened listing: 1) professional performance/professional identity

2) ethics/values, 3) education/training, and 4) quality/standards/

competencies. These professional characteristics are a helpful

conceptual frame for analyzing the conceptualization of the HP

profession and they are thus used to derive the research questions of

this scoping review, which aims to provide an overview of current

developments regarding the professional characteristics of HP.

While HP is clearly a central part of PH, it is important to

consider how the two are connected [21,22]. As in HP, the

professionalization discussion is also ongoing for PH

[10,23–25]. PH deals with a great variety of issues–including

prevention, health care and tackling the social determinants of

health [21, 26 ] (e.g., see 10 Essential Public Health Operations;

[27]) making PH very broad and complex to capture

[10,26,28–30]. Moreover, PH is described as research

orientated [28,31], and still overlaid by biomedical principles

[32,33] whereas HP is clearly practically orientated to address the

socioenvironmental determinants of health at a community level

with a bio-psycho-social perspective. PH has to recognize the

necessity of speciﬁ c skills for HP [34]. There are international

efforts to foster the professionalization of HP that are illustrated

by several indicators found in literature [2,14,21,22,35–37] and

shortly listed in Table 1. Although the specialization of

competencies in HP is a desirable outcome to tackle todays’

pressing health problems to foster quality standard in HP

practice, a gradual separation between PH and HP represents

a major challenge for HP and PH because the workforce capacity

of each discipline may be reduced by a segregation of these

interconnected disciplines. The professional HP development

within PH is therefore a great concern to the workforce,

which needs to be closely monitored in order to get the best

of both worlds: a clear proﬁle for HP professionals and a

synergistic interplay of HP and PH. We argue that identifying

the professional characteristics of HP in the literature helps to

foster the conceptualization of HP which contributes to the

professionalization and is a prerequisite for analyzing and

optimizing the interconnectedness between the HP and PH

professions. The aim of this study is therefore to provide an

overview of the professional characteristics of the HP profession

focusing on German compared to international literature.

METHODS

Literature on HP as a profession, especially empirical studies is

scarce [11,15]. Therefore, we conducted a scoping review as it

allows the inclusion of literature of lower scientiﬁc quality such as

grey literature, and is well suited to gain a broad and explorative

understanding of the research question and can even help to

specify it [38,39].

As outlined in the introduction, a summary of different

sociological professionalization theories referring to

professional characteristics on the institutional and individual

level [16–20] provided the conceptual background for the

research questions of this scoping review. Four categories in

which the professional characteristics are gathered were

differentiated: 1) Professional performance/professional

identity, 2) ethics/values, 3) education/training, and 4) quality/

standards/competencies. Building on the four distinct categories

of the different sociological professionalization theories [16–20]

described in the introduction we derived the following focal

research questions:

“What does the literature reveal about ...

1) ...the profession of HP, with a focus on professional identity

and professional performance?”

2) ... professional ethics/values of HP?”

3) ... education and training in HP?”

4) ... quality/standards or competencies of HP?”

Int J Public Health | Owned by SSPH+ | Published by Frontiers July 2021 | Volume 66 | Article 16039932

Biehl et al. Professional Characteristics of Health Promotion

In order to systemize the search strategy, we applied the PICO

scheme: P (opulation), I (ndicator), C (omparison), O (utcome of

interest) [39]. Although, not all categories were relevant for the

present research question, the scheme helped to specify the search

strategy. All keywords, synonyms and the Boolean operators that

have been used are shown in Table 2.

The search strategy employed three databases: CinahlComplete,

PubMed and the International Bibliography of the Social Science

(IBSS). The strategy was adapted to the search template in the

database. Moreover, speciﬁc journals were screened (Global Health

Promotion, Health Promotion International, Prävention und

Gesundheitsförderung (German) and Spectra (Swiss) and

Google Scholar was searched for grey literature. We also

conducted a hand search in the references of relevant literature.

The scoping review was conducted in March 2020.

Study selection was guided by inclusion criteria. We included 1)

any kind of theoretical and original (empirical studies and literature

reviews) literature, including journal articles and grey literature; 2)

literature that focuses on HP as deﬁned in the Ottawa Charta [1];

and 3) German as well as English literature in the review. The

German literature represented a special interest of the authors who

plan to conduct further research in the German speaking part of

Europe (Switzerland). The inclusion of international literature

supports the identiﬁcation of potential opportunities and

challenges within the conceptualization of the HP profession as

many countries have advanced further in the professionalization of

HP (e.g. Australia, New Zealand, Canada and Ireland) [6,22]. Finally,

we D) limited the publication date to 2012 to 2020 as we expected the

standardized competencies that were published by the IUHPE in

2011 in the CompHP core competencies framework of HP (37;

German version in 2014 [40]) to impact the professionalization

debate in HP. Figure 1 shows the search process including all

literature identiﬁed (N  1880), those who were rated as relevant

after screening the abstracts (n  119) and – in a second screening –

the full texts (n  90). For the content analysis, we selected original

literature only (n  37).

The data was collected in an Excel ﬁle containing relevant

information: author, nature of literature (journal article, grey

literature), year of publication, title, methods, aim, outcome and

country study conducted (see Table 3). Data analysis was based on

deductive and inductive principles. Within the deductive part, we

categorized the data comparable to the professional characteristics as

a theoretical basis of the search strategy. The data is described

quantitatively using frequencies (see Table 4). For the inductive data

analysis, we conducted a content-based literature analysis, which was

only applied to original literature (n  37) (see Table 3).

RESULTS

The search strategy revealed 90 publications, of which 31 are in

German language and 59 in English of which non was conducted in

a German speaking region. In total, 37 original publications

(empirical studies and literature reviews) published between 2012

and 2020 were identiﬁed, 24 of which were in English. An overall

lack of empirical studies on the HP profession was noteworthily,

especially in the German speaking countries but also internationally.

Table 4 provides further details about the descrip tive analysis of the

scoping review results of all 90 publications.

The content-based analyses revealed ﬁve major categories: 1)

profession, 2) ethics, 3) education/training, 4) competencies and 5)

quality. As the focus and content of the literature identiﬁed in the

TABLE 1 | International efforts to foster the professionalization of health promotion that are illustrated by several indicators found in literature [2, 14, 21, 22, 35–37]

(Professional characteristics of health promotion: a scoping review of German and international literature, Switzerland, 2021).

Indicators for professionalizing HP

internationally

1) Education and training programs in HP are established on an international level comprising bachelor’s and master’s degree programs and continuing education

2) Core competencies are deﬁned in a HP framework on an international level [37]

3) Research units specialize in HP (e.g. at the Universities of Ireland and Bielefeld) and speciﬁc scientiﬁc journals are published (e.g. Health Promotion Inte rnational, Global

Health Promotion, Prävention und Gesundheitsförderung)

4) National and international conferences on HP are held (e.g. World Conference on HP)

5) National and international professional institutions are established, especially the International Union for Health Promotion and Education (IUHPE)

6) Accreditation systems are available and applied, such as the “IUHPE Registered Health Promotion Practitioner”

7) National and international political priorities are established on HP (e.g. UN Sustainable Development Goals (SDG 3) or the German law on prevention and HP)

HP: health promotion.

TABLE 2 | Search strategy elaborated with PICO-scheme including search terms, synonyms and Boolean operators (Professional characteristics of health promotion: a

scoping review of German and international literature, Switzerland, 2021).

Boolean operators Search terms and synonyms

P (opulation) AND Health Promotion

I (ndicator) not relevant for this search strategy

C (omparison) NOT Public Health

O (utcome) AND professional identity OR collective identity OR vocational identity OR occupational identity OR identity OR identiﬁcation OR

profession

OR ethic

OR value OR norm OR behavior OR standard OR competenc

OR frame

, OR quality OR proﬁle OR

challenges OR education OR study OR training OR university

: truncations are used to allow more search results for speciﬁc keywords

Int J Public Health | Owned by SSPH+ | Published by Frontiers July 2021 | Volume 66 | Article 16039933

Biehl et al. Professional Characteristics of Health Promotion

scoping review partly differed from the professional characteristics

that have been outlined in the sociological theories, we speciﬁed

and adapted the names of the categories as follows: 1) “Profession”

summarizes literature focusing on HP as a profession including

professional performance and professional identity; 2) “Ethics”

summarizes literature regarding ethics and values of the HP

profession; 3) “Education/training” summarizes literature

describing training programs and study courses in HP; 4)

“Competencies” was separated from 5) “Quality” as a category

because there were numerous publications found which either

dealt with competencies of HP professionals–or with analyzing

quality standards of HP practice. The content of the original

publications is summarized in the following section (see

Table 3 for more details of all 37 original publications).

Profession

Three publications in German language discuss the HP profession,

focusing on education of HP [41], employees’ perspectives on the

profession [14] and an analysis of decision makers of HP

interventions in Germany [42]. Overall, the study’sresultsshow

unclear deﬁnitions and roles of HP practitioners, especially when

practitioners are not having an education or training in HP or a

related ﬁeld [14,41 ]. The variety of existing health related study

courses in Germany add to the intransparency of competencies and

curricula [14]. These barriers hinder the development of a

professional identity and the societal acceptance of the profession

[14 ]. Compared to the German literature, the English literature

(mainly Australia, Canada and United States) seems to fulﬁll

higher quality standards as they mostly consist of peer-reviewed

journal articles. Also, with respect to the content, English articles

focus on speciﬁc aspects of professional performance in HP, such as

critical reﬂection [43], sustainable practice [44,45]andon

socioecological determinants in interventions [8]. However,

English and German literature are both clear about the

importance of speciﬁcally trained HP competencies [8,14,42,45].

These publications variously emphasized the value of a code of

ethics, a meta theory in HP and a common professional proﬁle

including professional competencies that would help to promote

professionalization of HP regarding professional identity and

professional performance in HP.

Ethics

All six original publications identiﬁed are published in English

(mostly Australia) and focus on the ethical aspects of HP practice.

Some publications focus on deﬁning ethical dimensions of HP

[46,47], one focuses on challenges of empowerment applied in

FIGURE 1 | Flowchart of literature included in the scoping review. (Professional characteristics of health promotion: a scoping review of German and international

literature, Switzerland, 2021)

Int J Public Health | Owned by SSPH+ | Published by Frontiers July 2021 | Volume 66 | Article 16039934

Biehl et al. Professional Characteristics of Health Promotion

TABLE 3 | Data extraction of original publications identiﬁed in the scoping review chronologically ordered by category and language published (Professional characteristics of

health promotion: a scoping review of German and international literature, Switzerland, 2021).

Authors (nature

of literature)

Title Year Method Aim Outcome Country

Category: Profession

Zocher, U. (grey literature) About the challenge to study

and teach health

promotion–results of

participatory evaluation

2013 Mixed methods

evaluation study

Evaluating student’s

perspective on the

profession of HP

including

strength and challenges of

the study course

The holistic approach of HP for

some students is hard to

capture. Problematic are the

diverse professional

backgrounds of lecturers. Main

conclusions for

professionalization in HP are: 1)

Expert knowledge/professional

understanding (theory on HP), 2)

Didactic for HP (reﬂective

processes), 3) Leadership

culture in sense of HP

Germany (g)

Pawlis, S., Boettcher, A.,

Metzner, F., Plaumann, M.

and Walter, U. (journal

article)

Relevance and implementation

of prevention in Germany–a

national survey of decision

makers in health insurance

association, state and

communities

2015 Quantitative online

survey

Identifying the relevance and

implementation of HP and

prevention at decision

makers’ level at health

insurance companies, the

state and communities

Intervention of health insurances

are mainly pathogenetic

oriented, whereas interventions

of the state are also focusing on

social inequities. Policy makers

are more positive towards

capacity building in HP and

prevention than health insurance

companies. Main barriers are

ﬁnancial issues and personal

resources as well as unclear

roles.

Germany (g)

Walter, S. (master thesis) HP on the way to a

profession–an interview study

2015 Qualitative study using

interviews

Exploring the ﬁeld of action

and the need of HP

practitioners asking experts

in the ﬁeld

HP is currently performed by a

variety of professions. Most

organizations employ at least

one person with a professional

background in health sciences,

whereas related disciplines

(sports, nutrition) don’t see a

gain for the ﬁeld of action. There

are also persons working in HP

who don’t have any speciﬁcor

related training. There was

agreement on the need of

professionals in HP, but the

diversity of study programs in

Germany related to health are

seen as a barrier, lacking

transparent competencies.

Unclear deﬁnitions of roles in HP

are barriers for developing a

professional identity. The study

revealed clear chances of

professionalization of HP, but

some major challenges which

seem to be solvable.

Germany (g)

Golden, S. D. and Earp,

J. A. (journal article)

Social ecological approaches

to individuals and their

contexts: twenty years of

Health Education and Behavior

health promotion interventions

2012 Literature review Identifying socio-ecological

approaches in HP

interventions published in

the journal “health education

and behavior” between

1989 and 2008

Out of 157 articles, 2/3 focused

on the individual and not

specially on institutions,

communities or politics.

Interventions in settings like

schools or the community or

with topics such as nutrition and

physical activity were more often

integrating socio-ecological

approaches compared to other

topics. Competencies in HP

have to be strengthened in order

to address socio-ecological

determinants of health in

interventions.

United States (e)

(Continued on following page)

Int J Public Health | Owned by SSPH+ | Published by Frontiers July 2021 | Volume 66 | Article 16039935

Biehl et al. Professional Characteristics of Health Promotion

TABLE 3 | (Continued) Data extraction of original publications identiﬁed in the scoping review chronologically ordered by category and language published (Professional

characteristics of health promotion: a scoping review of German and international literature, Switzerland, 2021).

Authors (nature

of literature)

Title Year Method Aim Outcome Country

Harris, N. and Maria, S.

(journal article)

Deﬁning sustainable practice in

community-based health

promotion: A Delphi study of

practitioner perspectives

2013 Quantitative Delphi

study

Identifying deﬁnitions and

features of sustainable

practice in community-

based HP practice

Deﬁnitions of sustainable

practice highlight the importance

of collaboration, health

determinants, aspirations,

processes and outcomes. Four

speciﬁc features were identiﬁed:

1) effective relationships and

partnerships, 2) evidence-based

decision making and practice, 3)

emphasis on building

community capacity, 4)

supportive contexts

Australia (e)

Tretheway, R., Taylor, J.,

O’Hara, L. and Percival, N.

(journal article)

A missing ethical competency?

A review of critical reﬂection in

health promotion

2015 Narrative literature

review

Exploring the current use of

critical reﬂection in HP

Very limited literature exists on

critical reﬂection in HP, whereas

its potential to support critical

practice is widely

acknowledged. Critical reﬂection

is seen as a core competency for

HP practitioners to reﬂect the

ethical issues of HP practice.

Australia (e)

McFarlane, K., Judd, J.,

Devine, S. and Watt, K.

(journal article)

Reorientation of health

services: enablers and barriers

faced by organisations when

increasing health promotion

capacity

2016 Systematic literature

review

Identifying enablers and

barriers of primary health

care organizations

integrating HP approaches

and capacity building of HP

25 articles were identiﬁed which

summarize enablers for primary

health care organizations:

Management support, skilled

staff, committed stafﬁng and

ﬁnancial resources, leadership

and external partners to

collaborate; barriers were the

opposite of the enablers

including competing priorities to

HP within a health care

organization which is quite often

the case.

Australia (e)

Legrand, K., Minary, L. and

Briançon, S. (journal article)

Exploration of the experiences,

practices and needs of health

promotion professionals when

evaluating their interventions

and programs

2018 Quantitative written

survey

Describing practices of HP

practitioners regarding

evaluation of their

interventions and identifying

the need of an evaluation

and monitoring tool

More than half of 246

respondents in total had

dif

ﬁculties with conducting

process evaluation. On the one

hand selecting the proper

evaluation tool was difﬁcult and

on the other hand a lack of time

and ﬁnances. Authors identify a

need for an online tool for

evaluation of HP interventions.

Evaluation is a major

competence in HP practice.

France (e)

Category: Ethics

Carter, S. M., Klinner, C.,

Kerridge, I., Rychetnik, L.

and Li, V. (journal article)

The ethical commitment of

health promotion practitioners:

an empirical study from New

South Wales, Australia

2012 Qualitative study using

interviews

Describing the good in HP

by conducting interviews

and observations to

complete the theory of HP

ethics

Ethics in HP has substantive and

procedural dimensions:

substantive: meliorism, holism,

setting approach, focus on

primary prevention and

communities. Procedural:

interventions built on respectful

relationships, ﬂexible

collaboration with communities,

and are capabilities oriented and

sustainable.

Australia (e)

(Continued on following page)

Int J Public Health | Owned by SSPH+ | Published by Frontiers July 2021 | Volume 66 | Article 16039936

Biehl et al. Professional Characteristics of Health Promotion

TABLE 3 | (Continued) Data extraction of original publications identiﬁed in the scoping review chronologically ordered by category and language published (Professional

characteristics of health promotion: a scoping review of German and international literature, Switzerland, 2021).

Authors (nature

of literature)

Title Year Method Aim Outcome Country

Bull, T., Riggs, E. and

Nchogu, S. N. (journal

article)

Does health promotion need a

code of ethics? Results from

an IUHPE mixed methods

survey

2012 Online survey including

closed and open-

ended questions

Identifying the global need of

a code of ethics in HP

Low response rate (11.8%, N 

236). 83% conﬁrmed the need of

a code of ethics to clarify roles

and deﬁnitions of HP. Main

ethical issues are: equity, social

justice and respect. The

CompHP was seen as a

possible basis for developing a

code of ethics.

International

IUHPE (e)

Vallgarda, S. (journal article) Ethics, equality and evidence in

health promotion - Danish

guidelines for municipalities

2014 Documental analysis Analyzing the content of

Danish national guidelines

for HP regarding equity,

evidence and ethical

aspects

Results show a low integration of

equity, evidence and ethics in the

national guidelines for HP, even

though it was declared as an aim

of the Danish national board of

health. To meet this aims in

practice of HP, more effort of

public health authorities is

necessary.

Denmark (e)

Spencer, G. (journal article) “Troubling” moments in health

promotion: Unpacking the

ethics of empowerment

2015 Ethnographical mixed

methods study

Critical analyses of the

outcomes of empowerment

in HP interventions,

exempliﬁed with

adolescence health

Young adults’ health priorities

are set differently, e.g. smoking

and drinking promotes their

quality of life and self-

determination. The different

priorities raise some ethical

dilemmas for HP practice

regarding using empowerment.

This reinforces the importance of

ethical reﬂection of HP,

especially the dimension of

empowerment.

Australia (e)

Axford, A. and Carter, D.

(journal article)

Building workforce capacity for

ethical reﬂection in health

promotion: a practitioner’s

experience

2015 Case study Analyzing the effect of a

program for capacity

building in HP on the

inﬂuence of ethical reﬂection

in practice

The implemented program on

capacity building, which

consisted of different

components based on

organizational change

management, was evaluated by

participants to have a positive

impact on ethical reﬂection in

daily practice. The ethical

framework was seen as a very

practical tool. Challenges for

capacity building in this rural area

were different professional

backgrounds of HP

practitioners.

Australia (e)

Reilly, T., Crawford, G.,

Lobo, R., Leavy, J. and

Jancey, J. (journal article)

Ethics and health promotion

practice: exploring attitudes

and practices in Western

Australian health organizations

2016 Qualitative study using

interviews

Analyzing attitudes,

practices, enablers and

barriers of applied ethics in

HP practice

Out of ten interviews, most

practitioners include ethical

principals in their practice.

Enablers were: support with

ethical applications, tools and

training in ethical practice,

organizational support. Barriers

were: limited time resources,

little knowledge, ethical

application not noticed as one’s

task. HP practice is still lacking

evidence-based practice and

including ethical principles,

which must be amended in the

future.

Australia (e)

(Continued on following page)

Int J Public Health | Owned by SSPH+ | Published by Frontiers July 2021 | Volume 66 | Article 16039937

Biehl et al. Professional Characteristics of Health Promotion

TABLE 3 | (Continued) Data extraction of original publications identiﬁed in the scoping review chronologically ordered by category and language published (Professional

characteristics of health promotion: a scoping review of German and international literature, Switzerland, 2021).

Authors (nature

of literature)

Title Year Method Aim Outcome Country

Category: Education/training

Sachs, I. and University of

Applied Sciences

Neubrandenburg (grey

literature)

Study courses and job

perspectives of graduates in

nursing and health sciences

2014 Quantitative online

survey

Identifying: Conditions of

study program, progress,

competencies, follow up,

job search, job description,

job satisfaction

Participation of ﬁve study

programs: BA health science

results: 66% prior professional

education (BA), 56% satisﬁed,

15% dissatisﬁed with study

program, 2/3 direct access to

job, 1/3 master program, high

satisfaction with job situation,

broad ﬁeld of actions (few in HP

and prevention)

Germany (g)

Hartmann, T., Baumgarten,

K., Dadacynski, K. and

Stolze, N. (journal article)

Public health and health

promotion in Germany. State

of development of bachelor’s

and master’s courses

2015 Online search in data

bases for health-related

study programs in

Germany

Overview of accredited

study courses in public

health and HP in Germany

43 courses identiﬁed, 13

bachelor’s and 30 master’sat

universities and universities of

applied sciences, eight

bachelor’s, ﬁve master’s in HP,

great effort is necessary to

synchronize the curriculum

content

Germany (g)

Lang, G. and Gajar, P.

(journal article)

Continuing education and

training in health promotion. A

survey about intentions and

conditions among participants

of a countrywide seminar

program in Austria

2018 Quantitative online

survey

Identifying factors

inﬂuencing the intention to

participate in continuing

education and training in HP

Inﬂuencing factors identiﬁed:

Self-efﬁcacy, attitudes toward

seminars, social expectations of

signiﬁcant others, seminar

attendance in the past, interplay

of personal behavior and

institutional conditions

Austria (g)

Tremblay, M. C., Richard,

L., Brousselle, A. and

Beaudet, N. (journal article)

How can both the intervention

and its evaluation fulﬁll health

promotion principles? An

example from a professional

development program

2013 Case study Describing core principles of

HP, the professional

development program and

its evaluation (HP

Laboratory)

The HP Laboratory is a program

to foster HP competencies in

public health professionals.

Participants with different

professional backgrounds

working in health departments

developed a common

understanding of HP core

principles. Evaluation of the

program on HP principles was

challenging.

Canada (e)

Tremblay, M. C., Richard,

L., Brousselle, A. and

Beaudet, N. (journal article)

Learning reﬂexivity from a

health promotion professional

development program in

Canada

2014 Qualitative study using

interviews

Describing outcomes of

reﬂexivity of the professional

development program in

HP. Implications of reﬂexivity

for HP practice

Formal and critical reﬂection

are important me thods in HP

practice and helped the

participants to understand

their p rofessional roles.

Especially critical reﬂection

was hard t o encourage, b ut is

important for a critical societal

perspective on social justice

and equity concerns in HP.

Canada (e)

Wilkins, A., Lobo, R. C.,

Grifﬁn, D. M. and Woods, H.

A. (journal article)

Evaluation of health promotion

training for Western Australian

Aboriginal maternal and child

health sector

2015 Quantitative evaluation

study (online survey or

telephone interview)

Evaluation of a HP training

for health professionals -

impact of using information

given in the training - barriers

of implementing the

trainings’ resources in

practice

Low response rate (N  17);

diverse professional

backgrounds of participants;

Job descriptions often with HP,

but no training in HP; Chances of

the training: planning tools for

HP; networking in HP; Barriers:

lacking ﬁnances, low

organizational support

Australia (e)

Wiggins, N. and Pérez, A.

(journal article)

Using popular education with

health promotion students in

the United States

2017 Case study using mixed

methods

Evaluation of a course in

popular education method

within a master’s in public

health. This method is

supposed to train skills for a

systemic analysis of power

and privilege to address

health and social inequities.

The method was very useful for

students to learn focusing

attention and creating

community, cooperative learning

to support accountability to one

another and dramatic

techniques. Barriers for using

this method are students who

are not used to liberal pedagogy

United States (e)

(Continued on following page)

Int J Public Health | Owned by SSPH+ | Published by Frontiers July 2021 | Volume 66 | Article 16039938

Biehl et al. Professional Characteristics of Health Promotion

TABLE 3 | (Continued) Data extraction of original publications identiﬁed in the scoping review chronologically ordered by category and language published (Professional

characteristics of health promotion: a scoping review of German and international literature, Switzerland, 2021).

Authors (nature

of literature)

Title Year Method Aim Outcome Country

and controversy environment of

the university.

Torres, S., Richard, L.,

Guichard, A., Chicchio, F.,

Litvak, E. and Beaudet, N.

(journal article)

Professional development

programs in health promotion:

Tools and processes to favor

new practices

2017 Case study using mixed

methods

Evaluation of a professional

development program

which focuses on improving

HP interventions including

health promoting principles

The results showed positive

ﬁndings implementing several

principles of HP (equity, holism,

an ecological approach,

intersectorality and

sustainability). Participants had

problems integrating

empowerment a nd

participation in their

interventions developed.

Canada (e)

Komro, K. A., Lang, D. L.,

Reisinger Walker, E. and

Harper, P. D. (editorial)

Integrating structural

determinants into MPH training

of health promotion

professionals

2018 Review of curricula of

master’s in public

health

Identifying structural and

social determinants in

curricula of master’sin

public health in the

United States

16% of 275 master’s in public

health contain structural

determinants of health in the

curriculum: Study courses in

social science focus more on

social and structural

determinants of health;

interprofessional collaboration

is necessary to efﬁciently

address these determinants of

health

United States (e)

Category: Competencies

Baumgarten, K., Blättner,

B., Dadaczynski, K. and

Hartmann, T. (journal article)

The German professional

qualiﬁcation framework for

bachelor’s and master’s

degrees in health sciences/

public health and health

promotion

2015 Framework

development based on

content analysis

Developing a qualiﬁcation

framework for health

sciences/public health and

HP bachelor’s and master’s

programs to enable

comparability

Involving nine universities a

shared framework was

developed for bachelor’s

programs based on the Public

Health Action Cycle and Dublin

descriptors. No consensus was

found for the heterogenic

master’s programs.

Germany (g)

Karg, S., Blättner, B.,

Krüger, K. and Micheew, N.

(journal article)

Competences for working in

health promotion. Perceptions

of stakeholders

2020 Interview study Identifying stakeholders’

needs of competencies in

HP and possibilities for

students preparing for

employment during study

course

There was agreement on

professional competencies:

project management,

networking and teamwork,

conceptual work, research,

public communication, as well

as social competencies.

Stakeholders appreciate the

holistic approach of HP

practitioners.

Germany (g)

Speller, V., Parish, R.,

Davison and Zilnyk, A.

(journal article)

Developing consensus on the

CompHP professional

standards for health promotion

in Europe

2012 Mixed methods study Description of the process

of framework development

(CompHP) including testing

for acceptance at pan

European level

There was a great acceptance

and agreement upon the

framework CompHP. This goes

along with some concerns: 1)

high level for practitioners, 2)

developed for master’s

programs, 3) relationship

between Public Health and HP

United Kingdom

(e)

Madsen, W. and Bell, T.

(journal article)

Using health promotion

competencies for curriculum

development in higher

education

2020 Case study Analyzing chances and

challenges of one institution

by developing

undergraduate and

postgraduate courses

building on national

competencies of HP.

Main chances of implementing

national competencies in curricula

of HP education are transparency

and comparability. Challenging

were organizational structures,

characteristics of the study cohorts

and capacity of lecturers as well as

national and international

expectations. One main risk is the

lacking ﬂexibility of the curriculum.

This was fully obvious when

CompHP was developed

internationally in the meantime. The

institution could restructure the

curriculum again on CompHP.

Australia (e)

(Continued on following page)

Int J Public Health | Owned by SSPH+ | Published by Frontiers July 2021 | Volume 66 | Article 16039939

Biehl et al. Professional Characteristics of Health Promotion

TABLE 3 | (Continued) Data extraction of original publications identiﬁed in the scoping review chronologically ordered by category and language published (Professional

characteristics of health promotion: a scoping review of German and international literature, Switzerland, 2021).

Authors (nature

of literature)

Title Year Method Aim Outcome Country

Battel-Kirk, B., Van der

Zanden, G., Schipperen, M.

Contu, P., Gallardo, C., and

Barry, M. M. (journal article)

Developing a competency-

based pan-european

accreditation framework for

health promotion

2012 Mixed methods study

including focus groups,

online survey and web-

based consultation

Find consensus on

CompHP pan-European

accreditation framework for

HP practice, education and

training

405 participants out of 29

countries were involved in the

study. Mainly positive agreement

on an accreditation framework

to assure quality and

competence in HP. Barriers for

implementation were mentioned

regarding lacking resources for

implementation of the

accreditation framework.

Furthermore, the unclear

interrelationship between Public

Health and HP are barriers for

implementation in some

countries.

Europe (e)

Hicks, K. (grey literature) Health promotion

competencies baseline

implementation survey report

2013 Quantitative written

survey

Collecting information on the

current knowledge and

implementation of

New Zealands’ HP

competencies amongst the

HP workforce

105 responses revealed that

88% had at least some

knowledge on the national HP

competencies. The

competencies are used for

personal development plans,

performance reviews, planning

programs. They realized an

increase of clarity of their

professional role and

understanding of HP.

Challenges for implementing the

competencies were other

organizational priorities.

New Zealand (e)

Battel-Kirk, B. and Barry,

M.M. (journal article)

Has the development of health

promotion competencies

made a difference? A scoping

review of the literature

2019 Scoping review Explore current impact of

HP competencies on

practice, education and

training in Europe

39 sources were identiﬁed,

mainly focusing on competency

frameworks and their

development, some report on

the use of the frameworks and

only two evaluated the

frameworks. There is a lack of

studies on the implementation of

HP competencies.

Ireland and

Malta (e)

Battel-Kirk, B. and Barry, M.

M. (journal article)

Implementation of health

promotion competencies in

Ireland and Italy—A case study

2019 Case study including

desk reviews and semi-

structured interviews

Exploring the promoting and

challenging factors for

implementation of CompHP

at a national level comparing

two countries, Ireland and

Italy

The progress of CompHP

implementation reﬂected the HP

infrastructure and capacity in the

countries. Major limitations were

a lack of awareness of the

CompHP also by main

stakeholders and employees.

The CompHP has to be

promoted over the next years to

build capacity of HP.

Ireland and

Malta (e)

Battel-Kirk, B. and Barry,

M.M. (journal article)

Evaluating progress in the

uptake and impact of health

promotion competencies in

Europe

2020 Online survey

conducted with

consortium included in

the development of

CompHP

Identify attitudes regarding

the CompHP, level of

current and intended use

and opinions on their impact

Only 81 responses were

received from 25 countries:

attitudes were generally positive,

while only 53% conﬁrmed the

use of the CompHP in their

country. The competencies

were mainly used in education of

HP. Main barriers for

implementation of the CompHP

was the lacking recognition of

key organizations and

stakeholder at a national level.

Ireland and

Malta (e)

Category: Quality

Wright, M. T., Noweski, M.

and Robertz-Grossmann,

B. (journal article)

Quality development in primary

prevention and health

promotion. A survey of the

2012 Quantitative online

survey

Identify implementation of

quality development

strategies and standards

The results are very limited.

Responses conﬁrmed a great

variety of quality standards used

Germany (g)

(Continued on following page)

Int J Public Health | Owned by SSPH+ | Published by Frontiers July 2021 | Volume 66 | Article 160399310

Biehl et al. Professional Characteristics of Health Promotion

TABLE 3 | (Continued) Data extraction of original publications identiﬁed in the scoping review chronologically ordered by category and language published (Professional

characteristics of health promotion: a scoping review of German and international literature, Switzerland, 2021).

Authors (nature

of literature)

Title Year Method Aim Outcome Country

member organizations of the

Federal Association for

Prevention and Health

Promotion in Germany

used in HP and prevention in

Germany

in HP and prevention. Therefore,

the questionnaire could not be

answered properly. The authors

concluded that a qualitative

research approach is necessary

to capture the variety of quality

standards used in HP and

prevention.

Bär, G., Noweski, M., Ihm,

M. and Voss, A. (journal

article)

Prevention of overweight in

children: Standard setting

documents

2016 Literature review Assessing quality standards

of overweight prevention in

children found in databases

and google

German literature on quality

standards and overweight

prevention in children is rare.

Standard setting documents of

key stakeholders of HP and

prevention in Germany are

comparable with each other but

do not refer to each other.

Moreover, it is not clear which

document guides the quality

standards for overweight

prevention in children in

Germany.

Germany (g)

Grossmann, B. and

Noweski, M. (journal article)

Quality in primary prevention.

Results of a survey of

members of the Federal

Association for Prevention and

Health Promotion

2016 Qualitative study using

expert interviews

Exploring the current status

of quality standards used in

HP and prevention

42 experts were interviewed:

Using quality standards in

practice correlates with ﬁnancial

resources and qualiﬁed staff in

the institutions. Good practice

examples would be a helpful tool

as well as a nationwide

monitoring system. First, more

funding is required for assuring

quality standards in practice.

Germany (g)

Reisig, V., Kuhn, J., Loos,

S., Nennstiel-Ratzel, U.,

Wildner, M. and

Caselmann, W. H. (journal

article)

Primary prevention and health

promotion in Bavaria: Taking

stock

2016 Mixed methods

approach including an

online survey and

expert interviews

Assessing the status quo of

prevention and HP in

Bavaria, aiming at a quality-

oriented development of the

ﬁeld

HP and prevention practice

mainly address health literacy

and mental health issues by

providing health information

relating to behavior change

interventions. Rather low is the

engagement with gender

speciﬁc topics or socially

disadvantaged groups including

working with a setting approach

in communities. About half of the

participants include scientiﬁc

results in their project

development and 43% conduct

evaluations.

Germany (g)

Noweski, M., Bär, G., Voss,

A., Ihm, M. and Fricke, L.

(journal article)

Common quality standards in

primary prevention. The expert

survey PräKiT

2018 Qualitative study using

expert interviews

Identifying the need of

common quality standards

for HP and prevention

A common quality standard is

meaningful to the interviewed

experts. A complex and challenging

process to identify this common

standard is expected to meet

speciﬁc needs of different topics

within HP and prevention. Even

within these expert interviews no

theoretical saturation could be

revealed because expectation

varied meaningfully.

Germany (g)

HP: health promotion

(g): German.

(e): English.

Int J Public Health | Owned by SSPH+ | Published by Frontiers July 2021 | Volume 66 | Article 160399311

Biehl et al. Professional Characteristics of Health Promotion

HP interventions [48]. Further publications accentuate the

importance of the implementation of ethics into HP practice

[49,50] and also national guidelines for HP [51]. It is evident that

there is a substantial gap between theory and practice regarding

HP ethics, despite ethical considerations being mandatory when

planning and conducting interventions. As already recognized

within the category “profession,” a code of ethics in HP is needed

and asked for [41,46–48,50,51].

Education/Training

In total, nine original publications were identiﬁed that ﬁtthecategory

“education/training.” German as well as English publications display

a broad spectrum of thematic aspects. Some publications evaluate

professional training programs in HP for different professions

[52 –56]. These publications demonstrate that persons employed in

HP often don’t have any professional knowledge about it [55]. There

are also publications that study the HP competencies within a

master’s program in Public Health [32,57], which reveal major

gaps in the curriculum addressing social determinants of health

[32 ]. Finally, only a few publications focused on academic study

programs in HP. Only two were found from German speaking

regions [58,59] and these studies are not exclusively focusing on

HP but also included related study topics courses.

Competencies

Competencies are the basis for professional performance. In

total, nine publications were identiﬁed focusing on

competencies in HP, two of them in German. The German

publications don’t focus on the CompHP [60,61] but developed

an inc lusive framework for PH, health sciences and HP study

programs [59]. Most English publications focus o n the

development and implementation of the CompHP [6,62–64],

which is also adapted as an accreditation framework for HP

practitioners [65]. Australia [66] and New Zealand [67]also

edited own frameworks. The importance of common

professional competencies is afﬁrmed by all autho rs

[6,60–66]. It is seen as the basis for a common professional

proﬁle, f or transparent professional competencies, for a

common code of ethics and strong professional identities as

HP practitioners [63]. For more detailed literature on the

competencies, Battel-Kirk ’sandBarry’s scoping review from

2019 can be consulted [63].

Quality

All ﬁve original publications focusing on quality assurance of

HP and prevention inte rventions included in the content

analysis of this scoping review were con ducted in Germany.

Their overall aim was to identify quality standards that can be

used by primary stakeholders in HP and prevention [68–71].

Quality assurance of HP and prevention interven tions are still

fragmented and poorly standardized, although a

standardization of tools and activities is agre ed upon whe n

resources are available. Re garding the quality of HP

interventions as deﬁned in the Ottawa Charta, one arti cle

detected an insufﬁcient focus on social determinants of

health or on projects based o n the setting approach but a

strongfocusonbehaviorchangeprograms[7].

DISCUSSION

This scoping review aimed to outline the actual developments of

professional characteristics of HP with a focus on the German

speaking part of Europe taking international literature into

account. Of 90 publications that were identiﬁed, 37 were

original publications and about one-third of the theoretical

and original publications were contributions from the German

speaking context. Based on the content-analysis, the results were

summarized in categories that reﬂect the professional

characteristics: 1) profession, 2) ethics, 3) education/training 4)

competencies, and 5) quality. Content analysis was only applied

to the original literature (n  37). Overall, HP is clearly

developing as a profession especially in English speaking

countries, as literature was identiﬁed regarding all professional

characteristics [16] with the exception of the professional identity

of HP practitioners. German original literature did not address

“ethics” as a professional characteristic and only few publications

considering “competencies” and “education/training” were

identiﬁed. Thus, the discussion in the German original

literature was mostly focused on the two speciﬁc professional

characteristics of “education/training” and “quality.”

Furthermore, the quality of the German literature was lower

than the international literature (i.e., more grey literature than

peer-reviewed articles). Summing up the ﬁndings, the importance

of a common code of ethics in HP, a meta theory in HP and a

common professional proﬁle including professional

competencies are needed to promote professionalization of HP

regarding professional identity and professional performance of

HP practitioners.

In total, German original literature revealed that HP is rather

unclear in its conception and establishment as a profession, as

well as in terms of its relation to PH. The following factors

contribute to the confusion and intransparency of HP at an

educational level, within the labor market and in society. As

described in the introduction HP is not mentioned to be an

exclusive profession but is seen as a paradigm shift of our health

system [1]. Therefore, on the one hand a wide range of

professions (doctors, nurses, therapists, teachers, social

workers etc.) are called to promote health and integrate the

principles of the Ottawa Charta in their professional work:

participation, empowerment, and health equity. On the other

hand, we need HP professionals to initiate this paradigm shift,

conduct speciﬁc HP projects and mediate between important

stakeholder to foster Health in all Policies [12,34]. This can be

contradictory and in conﬂict with the goal to deﬁne clear

professional roles. There is a lack of studies describing the

contents and learning outcomes of HP programs, which are

needed to promote comparability and transparency of the

programs to deﬁne the professional roles of HP practitioners.

The confusion about health-related courses is reinforced by a

great expansion of these programs since the Bologna process in

1999. Study programs are named very differently (health sciences,

health communication, public health, health management, health

promotion etc.) but competencies and curricula are overlapping

[26,72,73] and seem to qualify students for HP practice.

Educational institutions competitively advertise for potential

Int J Public Health | Owned by SSPH+ | Published by Frontiers July 2021 | Volume 66 | Article 160399312

Biehl et al. Professional Characteristics of Health Promotion

students with a great variety of study programs which is fostered

since the Bologna process. Mainstreaming of HP can be

recognized in many health-related study courses. This

mainstreaming of HP in diverse sectors of health [2,22,74]

may lead to loss of quality of HP practice. To establish an

efﬁcient PH system including a strong HP workforce,

collaboration with a common language has to be the goal

instead of competing interests and economic factors at

educational institutions. More speciﬁc HP programs must be

established at universities with staff engaged in HP research and

practice. PH has to recognize the speciﬁc competencies for HP,

which are not sufﬁciently addressed in general PH programs,

even less in other health professions’ programs [34]. Literature

identiﬁed in the scoping review conclude that higher education

institutions are meant to play a signiﬁcant role to clarify HP’s

roles, promote its societal status and coordinate initiatives to

overcome the mainstreaming of HP [12,14,41].

Concerns about the quality of HP and prevention in practice

were identiﬁed in German original literature in terms of the poor

standards in planning, conducting and evaluating HP

interventions [7,68–71]. Most interventions are not based on a

setting approach and do not focus on social determinants of

health at a community level but address individual behavior

change instead [7]. Of course, the debate about the quality in

HP practice is inherently linked with competencies and the

education or training of persons working in the ﬁeld. Both,

the German and English literature point out that there is a

lack of expertise and professional knowledge in HP practice

[6,7,14,42,45]. Therefore, the CompHP framework by the

IUHPE is a good basis to build on, for educational purposes,

for the labor market to prioritize professional proﬁles , as well as

for governmental guidelines for HP [37]. The international

literature reveals few publications on competencies i n HP,

mostly the CompHP, but the implementation in the different

countriesisprogressingslowly[6,64]. The Germ an version of

the CompHP was published in 2014 [75]. Whereas original

literature showed no reference to the CompHP in 2015 [60],

theoretical publications in 2018 indicate the rising recognition

of the CompHP also in the German speaking part of Europe

[75,76]. Battel-Kirk and Barry (2019) point out that the

implementation progress of the CompHP reﬂects the

professionalization of HP i n the particular country [6,

64].

The competency framework for HP is meant to strengthen

professional identity and roles of the H P workfo rce [ 63].

Majorchallengesfortheimplementationarestructural

aspects, e.g. political commitment to HP, lacking

differentiation b etween HP and PH, a weak HP workforce

and lacking knowledge a bout the CompHP. Facilitators are a

strong HP professional institution, national accreditation of HP

andHPeducation[6,63]. Therefore, the CompHP inﬂue nces all

professional characteristics of HP, namely professional

performance and professional identity, ethics/values,

education/training and competencies/quality. Two further

initiatives are mentioned which promote clariﬁcation

regarding the professional characteristics of HP: Quality of

HP practice in the German speaking countries is enhanced

by “Quintessenz” a widely known online network and project-

management-tool, whi ch ensures a systematic and high quality

proceeding in HP practice [77]. An internationally commi tted

code of ethics in HP still needs to be established. Beside s the

CompHP the code of ethics of health education professionals in

the Un ited States [78] can also be drawn upon. There have been

made great p rofessi onal a chievement s in HP within the last

years (see Ta ble 1). Therefore, we need a young professionally

trained HP workforce t o further promote their visibility and

competencies to address actual and future challenges of socie ty’s

health.

Limitations

Searching the databases and journals revealed an abundance

of English literature but a scarcity of German literature.

Therefore, we conducted an extended search for grey

literature in Google Scholar and a hand search for the

German literature. This may have led to an increased

amount of grey literature in the German relative to the

English literature . As the main a im of the scopin g review

was to identify professional characteristics of HP in the

German speaking part of Europe with comparison to the

international literature, this limitation should not invalidate

the ﬁndings. Furthe r, abstracts and full texts were only single-

screened, which represents a methodological limitation.

However, this proceeding is often applied in scoping

reviews and can even be justiﬁed for systematic reviews [79].

TABLE 4 | Descriptive analysis of data included in the scoping review (Professional

characteristics of health promotion: a scoping review of German and

international literature, Switzerland, 2021).

Total Language

N German English

90 (100%) 31 (34.4%) 59 (65.6%)

Form of literature

Theoretical 53 (58.9%) 18 (20.0%) 35 (38.9%)

Original article 37 (41.1%) 13 (14.4%) 24 (26.7%)

Categories

Profession 34 (37.8%) 10 (11.1%) 24 (26.7%)

Theoretical 26 7 19

Original article 8 3 5

Ethics 21 (23.3%) 5 (5.6%) 16 (17.8%)

Theoretical 15 5 10

Original article 6 — 6

Education/training 16 (17.8%) 6 (6.7%) 10 (11.1%)

Theoretical 7 3 4

Original article 9 3 6

Competencies 12 (13.3%) 4 (4.4%) 8 (8.9%)

Theoretical 3 2 1

Original article 9 2 7

Quality 7 (7.8%) 6 (6.7%) 1 (1.1%)

Theoretical 2 1 1

Original article 5 5 —

Int J Public Health | Owned by SSPH+ | Published by Frontiers July 2021 | Volume 66 | Article 160399313

Biehl et al. Professional Characteristics of Health Promotion

Conclusion

Analyzing international literature on professional

characteristics of HP re veals the necessity of clarifying

competencies and the professional proﬁle of HP. The lack of

expertise and professional knowledge in HP practice in the

German speaking part of Europe as well as internationally

[6,7,14,41,44] indicates the need for clariﬁ cation regarding

specialized competencies of HP within the PH ﬁeld.

Therefore, integrating the CompHP in national and regional

HP institutions, at an educational level, as well as in relation to

theworkforceandlabormarketwouldhelptoaddressthese

needs. The lack of recognition of t he CompHP is evident in the

identiﬁed literature, especially in the German speaking

countries, and must be of concern in future investigations on

the HP profession. The unclear relationship and differentiation

between HP and PH further hinders the conceptualization of the

HP profession [6,62]. Higher education institutions play a major

role in clarifying the intercon nectedness between HP and PH,

addressing this by adapting curri cula and names of their study

programs. HP as a profession and HP professionals would

beneﬁt from being trained based on the CompHP, which

reﬂects professional competencies for HP based on the

Ottawa Charta. Transparency and comparability of

competencies of the HP, PH and the wider health workforce

contribute to the political and societal recognit ion of important

professions in nat ional and international efforts to tackle rising

social inequalities of health and global health issue s (infe ctious

and non-comm unicable diseases).

AUTHOR CONTRIBUTIONS

VB developed the conceptual idea, conducted the scoping review

and wrote the manuscript. TG supervised the project and

contributed to the manuscript. FW contributed substantially to

the conceptual idea of the project and the manuscript and

supervised the project.

CONFLICT OF INTEREST

The authors declare that the research was conducted in the

absence of any commercial or ﬁnancial relationships that

could be construed as a potential conﬂict of interest.

ACKNOWLEDGMENTS

We would like to thank Victoria Saint for proof reading and

editing the English of the manuscript.

REFERENCES

1. WHO. Ottawa Charta for Health Promotion. Ottawa: World Health

Organization; (1986).

2. Kickbusch, I, and Nutbeam, D. A Watershed for Health Promotion. Health

Promot Int (2017). 32(1):2–6. doi:10.1093/heapro/daw112

3. Transforming, UN. Our World: The 2030 Agenda for Sustainable Development.

[Internet]. New York, NY: United Nations (2015). [cited 2020 May 23].

Available from: https://www.un.org/ga/search/view_doc.asp?symbolA/RES/

70/1&LangE.

4. Kickbusch, I. 21st century Determinants of Health and Wellbeing: a New

challenge for Health Promotion. Glob Health Promot (2012). 19(3):5–7.

doi:10.1177/1757975912454783

5. T Schott and C Hornberg, editors. Die Gesellschaft und ihre Gesundheit: 20

Jahre Public Health in Deutschland: Bilanz und Ausblick einer Wissenschaft. 1.

Auﬂ. Wiesbaden: VS Verlag für Sozialwissenschaften (2011). p. 682

(Gesundheit und Gesellschaft).

6. Battel-Kirk, B, and Barry, MM. Implementation of Health Promotion

Competencies in Ireland and Italy-A Case Study. IJERPH (2019). 16(24):

4992. doi:10.3390/ijerph16244992

7. Reisig, V, Kuhn, J, Loos, S, Nennstiel-Ratzel, U, Wildner, M, and Caselmann,

W. Primärprävention und Gesundheitsförderung in Bayern - eine explorative

Bestandsaufnahme. Gesundheitswesen (2016). 79(04):238–46. doi:10.1055/s-

0042-108585

8. Golden, SD, and Earp, JAL. Social Ecological Approaches to Individuals and

Their Contexts. Health Educ Behav (2012). 39(3):364–72. doi:10.1177/

1090198111418634

9. Paccaud, F, Weihofen, A, and Frank, M. Public Health Workforce in

Switzerland: Are Public Health Workers Lacking? Int J Public Health

(2013). 58(6):799–800. doi:10.1007/s00038-013-0481-2

10. Hommes, F, Alpers, K, Reime, B, and Rexroth, U. Durch attraktive Karrierewege

Public Health in Deutschland nachhaltig stärken - Kernforderungen an eine

Public-Health-Strategie für Deutschland im Bereich Human Resources.

Gesundheitswesen (2020). 82(04):303–5. doi:10.1055/a-1082-0890

11. Walther, K. Professionspfade in der Gesundheitsförderung. Analysen zur

gesundheitsfördernden Arbeit in Arbeitsmarkt, Ausbildung und Beruf.

Osnabrück. Der andere Verlag (2002).

12. Göpel, E. Professionalisierung der Gesundheitsförderung und mögliche

Konsequenzen für die Aus- und Weiterbildung der Gesundheitsberufe. In

Professionalisierung im Gesundheitswesen. Bern: Hans Huber. Hogrefe AG

(2006). p. 159–74.

13. Bals T, and Wulfhorst, B. Gesundheitsförderung als Beruf. In:

Gesundheitsförderung in pädagogischen Settings. Weinheim, München:

Juventa (2008). p. 113–33.

14. Walter, S. Gesundheitsförderung auf dem Weg zur Profession - eine

Interviewstudie [Masterarbeit]. [Schwäbisch Gmünd]. Pädagogische

Hochschule Schwäbisch Gmünd (2015).

15. Streckeisen U. Gesundheitsförderung als Beruf? Aspekte der Ausbildung,

Beschäftigung und Berufspolitik hinsicht lich Public Health. In Alte und

neue Gesundheitsberufe. Zürich: Lit Orlux (2013).

16. Mieg, H. Profession: Begriff, Merkmale, Gesellschaftliche Bedeutung. In: M Dick,

W Marotzki, and H Mieg, editors. Handbuch Professionsentwicklung. Bad Heilbrunn.

Verlag Julius Klinkhardt (2016). p. 27–40.

17. Carr-Saunders, AM, and Wilson, PA. The Professions. 1

. Oxford: Clarendon

Press (1933).

18. Wilensky, HL. The Professionalization of Everyone? Am J Sociol (1964). 70(2):

137–58. doi:10.1086/223790

19. Beck,U,Brater,M,andDaheim,H.Soziologie der Arbeit und der Berufe: Grundlage,

Problemfelder, Forschungsergebnisse. Reinbek bei HamburgRowohlt (1980).

20. Oevermann, U. Theoretische Skizze einer revidierten Theorie professionellen

Handelns. In Pädagogische Professionalität Untersuchungen Zum Typus

Pädagogischen Handelns. Frankfurt: Suhrkamp (1996). p. 276–302.

21. Faltermaier, T, and Wihofszky, P. Gesundheitsförderung und Prävention im

Kontext von Public Health. In: Schott T, Hornberg C, editors. Die Gesellschaft

und ihre Gesundheit. Wiesbaden: Springer (2011). p. 257–74.

22. Van Den Broucke, S. Strengthening Health Promotion Practice: Implementation

Systems and Capacity Development [Internet]. Workshop: Health Promotion: An

Integrative Paradigm for Sustainable Health, Wellbeing and Development Presented at:

WorldCongressonPublicHealth(2020). [cited 2020 Nov 19]; Rome (online).

Int J Public Health | Owned by SSPH+ | Published by Frontiers July 2021 | Volume 66 | Article 160399314

Biehl et al. Professional Characteristics of Health Promotion

Available from: https://www.iuhpe.org/images/IUHPE/News/WCPH2020/WCPH_

Van-den-Broucke_13_oct_6E.pdf.

23. Czabanowska K, Laaser U, and Stjernberg, L. Shaping and authorising a public

health profession. South Eastern European Journal of Public Health (SEEJPH).

(2014).(2).

24. Gershuni, O, Czabanowska, K, Burazeri, G, Cichowska Myrup, A, and Von

Krauss, M K. Is There a golden Recipe? A Scoping Review of Public Health

Workforce Development . Eur J Public H ealth (2019). 29(3):401–8.

doi:10.1093/eurpub/cky247

25. Foldspang, A. Towards a Public Health Profession: the Roles of Essential

Public Health Operations and Lists of Competence s. Eur J Public Health

(2015). 25(3):361–2. doi:10.1093/eurpub/ckv007

26. Gerlinger,T,Babitsch,B,Blättner,B,Bolte,G,Brandes,I,Dierks,M-L,

et al. Situation und Perspektiven von Public Health in Deutschland -

Forschung und Le hre. Gesundheitswesen (2012). 74(11):762–6.

doi:10.1055/s-0032-1330011

27. WHO. The 10 Essential Public Health Operations [Internet] (2020). [cited 2020

Nov 1 1]. Available from: https://www.euro.who.int/en/health-topics/

Health-systems/public-health-services/policy/the-10-essential-public-

health-operations.

28. Adelberger, BC. Anforderungen im Arbeitsmarkt Public Health. Anregungen

für die curriculare Schwerpunktsetzung im Fachbereich [Dissertation]. Berlin]:

TU Berlin (2013).

29. Hinz, J. Akademisierung von Gesundheit(-sberufen) - Chancen,

Herausforderungen und Perspektiven der Public Health-Ausbildung für das

Berufsfeld Gesundheit. In Eine Markt- und Potenzialanalyse [Dissertation].

[Bielefeld]. Universität Bielefeld (2018).

30. Dierks, M. Aus-, Fort- und Weiterbildung in Public Health – wo stehen wir

heute?: Plenarvortrag im Rahmen des Zukunftsforums Public Health. Berlin

2016 Gesundheitswesen (2017). 79(11):954–9.

31. Lorenz, H-J, and Pundt, J. Professionalisierung durch Public Health – Eine

Verbleibsanalyse Berliner Public Health-Absolventen. Jahrbuch für Kritische

Medizin und Gesundheitswissenschaften. (2002). 37:96–118.

32. Komro, KA, Lang, DL, Walker, ER, and Harper, PD. Integrating Structural

Determinants into MPH Training of Health Promotion Professionals. Am

J Public Health (2018 ). 108(4):477–9. doi:10.2105/ajph.2018.304309

33. McQueen, DV, and Kickbusch, I. Introduction. In Health & Modernity. New

York: Springer (2007). p. 1–5. doi:10.1007/978-0-387-37759-9_1

34. Kemm, J. Health Promotion: Ideology, Discipline, and Specialism. Oxford

University Press (2014). doi:10.1093/med/9780198713999.001.0001

35. Kaba-Schönstein, L. Gesundheitsförderung 3: Entwicklung nach Ottawa.

Leitbegriffe der Gesundheitsförderung und Prävention: Glossar zu Konzepten

[Internet] (2018). [cited 2020 Nov 19]; Available from: https://www.leitbegriffe.

bzga.de/systematisches-verzeichnis/kernkonzepte-und-entwicklungen-der-

gesundheitsfoerderung/gesundheitsfoerderung-iii-internationale-entwicklung-

historische-und-programma tische-zusammenhaenge-nach-ottawa-1986-bis-

heute.

36. Studiengang Gesundheitsförderung und -management in Europa.

Professionalisierung der Gesundheitsförderung: Bilanzierung von Policy-,

Praxis- und Wissenschaftsentwicklung auf dem Weg zur nachhaltigen

Gesundheitsförderung in Deutschland, Österreich und der Schweiz.

Hochschulen für Gesundheit (2012).

37. Dempsey, C, Battel-Kirk, B, and Barry, MM. CompHP Project Partners. The

CompHP Core Competencies Framework for Health Promotion (Short Version).

IUHPE (2011).

38. Arksey, H, and O’Malley, L. Scoping Studies: towards a Methodological

Framework. Int J Soc Res Methodol (2005). 8(1):19–32. doi:10.1080/

1364557032000119616

39. Tricco,AC,Lillie,E,Zarin,W,O

’Brien,KK,Colquhoun,H,Levac,D,etal.

PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and

Explanation. AnnInternMed(2018). 169(7):467–73. doi:10.7326/m18-

0850

40. Barry MM, ed. Bundeszentrale für gesundheitliche Aufklärung, Das CompHP-

Rahmenkonzept für die Gesundheitsförderung: Kernkompetenzen-professionelle

Standards-Akkreditierung. Deutsche Kurzfassung. Auﬂ.: 1.2.03.14.Köln:BZgA

(2014). p. 44. (Konzepte). Available at: https://www.bzga.de/infomaterialien/

fachpublikationen/fachpublikationen/band-5-das-comphp-rahmenkonzept-fuer-

die-gesundheitsfoerderung/.

41. Zocher, U. Über die Herausforderung Gesundheitsförderung zu studieren und zu

lehren – Ergebnisse partizipativer Begleitforschung. [Internet]. Dossenheim (2013).

[cited 2020 Mar 1]. Ava ilable from: http://www.gesundheitsfoerderung-studieren.de/

images/pdf/synopse_2008-2012_UZ-1%20Kopie%20.pdf.

42. Pawils, S, Boettcher, A, Metzner, F, Plaumann, M, and Walter, U. Stellenwert und

Umsetzung der Prävention in Deutschland - Eine bundesweite Befragung von

Entscheidungsträgern in GKV-Spitzenverband, Bund, Ländern und Kommunen.

Gesundheitswesen (2015). 77(S 01):S12–S13. doi:10.1055/s-0035-1559611

43. Tretheway, R, Taylor, J, O’Hara, L, and Percival, N. A Missing Ethical

Competency? A Review of Critical Reﬂection in Health Promotion. Health

Promot J Austr (2015). 26(3):216–21. doi:10.1071/he15047

44. Harris, N, and Sandor, M. Deﬁning Sustainable Practice in Community-Based

Health Promotion: A Delphi Study of Practitioner Perspectives. Health Promot

J Austr (2013). 24(1):53 –60. doi:10.1071/he12908

45. McFarlane, K, Judd, J, Devine, S, and Watt, K. Reorientation of Health Services:

Enablers and Barriers Faced by Organisations when Increasing Health

Promotion Capacity. Health Promot J Austr (2016). 27(2):118–33.

doi:10.1071/he15078

46. Bull, T, Riggs, E, and Nchogu, SN. Does Health Promotion Need a Code of

Ethics? Results from an IUHPE Mixed Method Survey. Glob Health Promot

(2012). 19(3):8–20. doi:10.1177/1757975912453181

47. Carter, SM, Klinner, C, Kerridge, I, Rychetnik, L, Li, V, and Fry, D. The Ethical

Commitments of Health Promotion Practitioners: An Empirical Study from

New South Wales, Australia. Public Health Ethics (2012). 5(2):128–39.

doi:10.1093/phe/phs014

48. Spencer, G. ’Troubling’ Moments in Health Promotion: Unpacking the Ethics

of Empowerment. Health Promot J Austr (2015). 26(3):205–9. doi:10.1071/

he15049

49. Reilly, T, Crawford, G, Lobo, R, Leavy, J, and Jancey, J. Ethics and Health Promotion

Practice: Exploring Attitudes and Practices in Western Australian Health

Organisations. Health Promot J Austr (2016). 27(1):54–60. doi:10.1071/he15059

50. Axford, A, and Carter, D. Building Workforce Capacity for Ethical Reﬂection

in Health Promotion: a Practitioner’s Experience. Health Promot J Austr

(2015). 26(3):222

–30. doi:10.1071/he15031

51. Vallgarda, S. Ethics, equality and Evidence in Health Promotion Danish

Guidelines for Municipalities. Scand J Public Health (2014). (42) 337–43.

doi:10.1177/1403494814525007

52. Lang, G, and Gajar, P. Fort- und Weiterbildung in der Gesundheitsförderung:

Eine Befragung über Absichten und Bedingungen unter Teilnehmern eines

österreichweiten Seminarprogramms. Präv Gesundheitsf (2018). 13(1):24–31.

53. Tremblay, M-C, Richard, L, Brousselle, A, and Beaudet, N. Learning Reﬂexively

from a Health Promotion Professional Development Program in Canada. Health

Promot Int (2013). 29(3):538–48. doi:10.1093/heapro/dat062

54. Torres S, Richard L, Guichard A, Chiocchio F, Litvak E, and Beaudet N.

Professional Development Programs in Health Promotion: Tools and

Processes to Favor new Practices. Health Promot Int (2017).(32) 587–98.

doi:10.1093/heapro/dav097

55. Wilkins, A, Lobo, RC, Grifﬁn, DM, and Woods, HA. Evaluation of Health

Promotion Training for the Western Australian Aboriginal Maternal and

Child Health Sector. Health Promot J Austr (2015). 26:57–63.

56. Tremblay, M-C, Richard, L, Brousselle, A, and Beaudet, N. How Can Both the

Intervention and its Evaluation Fulﬁ ll Health Promotion Principles? an

Example from a Professional Development Program. Health Promot Pract

(2013). 14(4):563–71. doi:10.1177/1524839912462030

57. Wiggins, N, and Pérez, A. Using Popular Education with Health Promotion

Students in the USA. Health Promot Int (2017). 32:660–70. doi:10.1093/

heapro/dav121

58. Hartmann, T, Baumgarten, K, Dadaczynski, K, and Stolze, N.

Gesundheitswissenschaften/Public Health und Gesundheitsförderung in

Deutschland. Präv Gesundheitsf (2015). 10(3):239–46. doi:10.1007/s11553-

015-0495-0

59. Sachs I, Hochschule Neubrandenburg, editors. Studium, Studienverlauf und

Berufsperspektiven von Absolventinnen und Absolventen Pﬂege- und

Gesundheitswissenschaftlicher Studiengänge. Neubrandenburg: Hochschule

Neubrandenburg (2014). p. 178 (Schriftenreihe der Hochschule

Neubrandenburg G).

60. Baumgarten,K,Blättner,B,Dadaczynski,K,andHartmann,T.Entwicklungeines

Fachqualiﬁkationsrahmens für die Studienbereiche Gesundheitswissenschaften/

Int J Public Health | Owned by SSPH+ | Published by Frontiers July 2021 | Volume 66 | Article 160399315

Biehl et al. Professional Characteristics of Health Promotion

Public Health und Gesundheitsförderung in Deutschland. Präv Gesundheitsf

(2015). 10(4):320–7. doi:10.1007/s11553-015-0507-0

61. Karg S, Blättner B, Krüger K, and Micheew N. Kompetenzen für Tätigkeiten in

der Gesundheitsförderung: Sichtweisen von Stakeholdern. Präv Gesundheitsf.

(2020).(15):236–41.

62. Speller, V, Parish, R, Davison, H, and Zilnyk, A. Developing Consensus on the

CompHP Professional Standards for Health Promotion in Europe. Health Educ

Behav (2012). 39(6):663–71. doi:10.1177/1090198112467802

63. Battel-Kirk, B, and Barry, MM. Has the Development of Health Promotion

Competencies Made a Difference? A Scoping Review of the Literature. Health

Educ Behav (2019). 46(5):824–42. doi:10.1177/1090198119846935

64. Battel-Kirk, B, and Barry, MM. Evaluating Progress in the Uptake and Impact of

Health Promotion Competencies in Europe. Health Promot Int (2020). 35(4):

779–89.

65. Battel-Kirk, B, Van der Zanden, G, Schipperen, M, Contu, P, Gallardo, C,

Martinez, A, et al. Developing a Competency-Based Pan-European

Accreditation Framework for Health Promotion. Health Educ Behav

(2012). 39(6):672–80. doi:10.1177/1090198112466664

66. Madsen, W, and Bell, T. Using Health Promotion Competencies for

Curriculum Development in Higher Education. Glob Health Promot (2012).

19(1):43–9. doi:10.1177/1757975911428818

67. Hicks, K. Ng



a Kaiakatanga Hauora M



o Aotearoa - Health Promotion

Competencies for Aotearoa New Zealand. [Internet]. Auckland: Healh

Promotion Forum of New Zealand (2013). [cited 2020 Apr 10] p. 6.

Available from: http://www.hauora.co.nz/assets/ﬁles/Health%20Promotion%

20Competencies%20%20Final.pdf.

68. Bär, G, Noweski, M, Ihm, M, and Voss, A. Übergewichtsprävention bei

Kindern: Standard setzende Dokumente. Bundesgesundheitsbl (2016).

59(11):1405–14. doi:10.1007/s00103-016-2450-4

69. Grossmann, B, and Noweski, M. Qualität in der Primärprävention. Ergebnisse

einer Mitgliederbefragung der Bundesvereinigung Prävention und

Gesundheitsförderung e. V. Gesundh Ökon Qual Manag (2016). 21(03):163–7.

70. Noweski, M, Bär, G, Voss, A, Ihm, M, and Fricke, L. Qualitätssta ndards in der

Primärprävention. Präv Gesundheitsf (2018). 13(2):97–102. doi:10.1007/

s11553-017-0630-1

71. Wright, MT, Noweski, M, and Robertz-Grossmann, B. Qualitätsentwicklung

in Primärprävention und Gesundheitsförderung. Praev Gesundheitsf (2012).

7(1):11–7. doi:10.1007/s11553-011-0317-y

72. Bollinge r, H, Gerlach, A, and Pfadenhauer, M. Soziologie und Gesundheitsberufe.

In Gesundheitsberufe im Wandel. 4. Frankfurt am Main: Mabuse-Verlag (2016).

p. 7–12.

73. Borgetto, B. Ausbildung, Akademisierung und Professionalisierung der

therapeutischen Gesundheitsberufe in Deutschland. In Alte und neue

Gesundheitsberufe. Zürich: Lit Orlux (2013). p. 138–60.

74. Jackson, SF. Mainstreaming Health Promotion. Glob Health Promot (2011).

18(2):03–4. doi:10.1177/1757975911404642

75. Szabo, B, Gollner, E, and Schnabel, F. Personalisiertes und forschungsgeleitetes

Lehren und Lernen als integrale Bestandteile der Lehr- und Lernstrategie des

Masterstudienganges “Gesundheitsförderung und Gesundheitsforschun g“ an

der Fachhochschule Burgenland. Pädagogik der Gesundheitsberufe. (2018). 1:8.

76. Niederberger, M, and Kahlert, D. Forschendes Lernen in der Methodenlehre:

Eine Diskussion anhand eines Fallbeispiels aus der Gesundheitsförderung. die

hochschullehre (2018). 4:531–51.

77. Kolip P, A ckermann G, Ruckstuh l B, and Studer, H. Gesundheitsförderung

mit System. 2nd ed. Bern: Hogrefe (2019).

78. Coalition for National Health Education Organizations (CNHEO). Code of Ethics for

the Health Education Profession [Internet] (2020). [cited 2021 Jan 4]. Available from:

https://assets.speakcdn.com/assets/2251/CodeofEthicsfull2020.pdf.

79. Waffenschmidt, S, Knelangen, M, Sieben, W, Bühn, S, and Pieper, D. Single

Screening versus Conventional Double Screening for Study Selection in

Systematic Reviews: a Methodological Systematic Review. BMC Med Res

Methodol (2019). 19(1):132. doi:10.1186/s12874-019-0782-0

distributed under the terms of the Creative Commons Attribution License (CC

BY). The use, distribution or reproduction in other forums is permitted, provided the

original author(s) and the copyright owner(s) are credited and that the original

publication in this journal is cited, in accordance with accepted academic practice.

No use, distribution or reproduction is permitted which does not comply with

these terms.

Int J Public Health | Owned by SSPH+ | Published by Frontiers July 2021 | Volume 66 | Article 160399316

Biehl et al. Professional Characteristics of Health Promotion